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Transforming the understanding
and treatment of mental illnesses.

Depression

Overview

Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.

To be diagnosed with depression, the symptoms must be present for at least two weeks.

There are different types of depression, some of which develop due to specific circumstances.

  • Major depression, which includes symptoms of depression most of the time for at least 2 weeks that typically interfere with one’s ability to work, sleep, study, and eat.
  • Persistent depressive disorder (also called dysthymia), which often includes less severe symptoms of depression that last much longer, typically for at least 2 years.
  • Perinatal depression, which occurs when a woman experiences major depression during pregnancy or after delivery (postpartum depression).
  • Seasonal affective disorder, which comes and goes with the seasons, typically starting in late fall and early winter and going away during spring and summer.
  • Depression with symptoms of psychosis, which is a severe form of depression where a person experiences psychosis symptoms, such as delusions (disturbing, false fixed beliefs) or hallucinations (hearing or seeing things that others do not see or hear).

Individuals with bipolar disorder (formerly called manic depression or manic-depressive illness) also experience depressive episodes, in which they feel sad, indifferent, or hopeless, combined with a very low activity level. But a person with bipolar disorder also experiences manic episodes, or unusually elevated moods in which the individual might feel very happy, irritable, or “up,” with a marked increase in activity level.

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

Signs and Symptoms

The Centers for Disease Control and Prevention (CDC) has recognized that having certain mental disorders, including depression and schizophrenia, can make people more likely to get severely ill from COVID-19. Learn more about getting help and finding a health care provider on NIMH's Help for Mental Illnesses webpage.

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Feelings of irritability, frustration, or restlessness 
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy, fatigue, or feeling "slowed down"
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early morning awakening, or oversleeping
  • Changes in appetite or unplanned weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment
  • Suicide attempts or thoughts of death or suicide

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment as well. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Risk Factors

Depression is one of the most common mental disorders in the U.S. Research suggests that genetic, biological, environmental, and psychological factors play a role in depression.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present, and research suggests that people who have depression and another medical illness tend to have more severe symptoms of both illnesses. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medications

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no "one-size-fits-all" for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Antidepressants are medicines commonly used to treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 4 to 8 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before deciding whether it works.

If you begin taking antidepressants, do not stop taking them without talking to your doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit the FDA website.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or "counseling") can help people with depression by teaching new ways of thinking and behaving and how to change habits that contribute to depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). More information on psychotherapy is available on the NIMH Psychotherapies webpage.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
  • Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
  • Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for most patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
  • ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

Natural Products

FDA has not approved any natural products for depression. While research is ongoing, some people find natural products, including vitamin D and the herbal dietary supplement St. John’s wort, to help depression. Do not use St. John’s wort or other dietary supplements for depression before talking to your provider. For more information, visit the National Center for Complementary and Integrative Health website.

How can I find help?

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Once you begin treatment, you should gradually start to feel better. Here are other tips that may help you or a loved one during treatment for depression:

  • Try to get some physical activity. Just 30 minutes a day of walking can boost mood.
  • Try to maintain a regular bedtime and wake-up time.
  • Eat regular, healthy meals.
  • Do what you can as you can. Decide what must get done and what can wait.
  • Try to connect with other people, and talk with people you trust about how you are feeling.
  • Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better.
  • Avoid using alcohol, nicotine, or drugs, including medications not prescribed for you.

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may receive better help in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials have uncovered. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

Learn More

Free Brochures and Shareable Resources

  • Chronic Illness and Mental Health: Recognizing and Treating Depression: This brochure provides information about depression and mental health for people living with chronic illnesses, including children and adolescents. It discusses symptoms, risk factors and treatment options.
  • Depression: This brochure provides information about depression including the different types of depression, signs and symptoms, how it is diagnosed, treatment options, and how to find help for yourself or a loved one.
  • Depression in Women: 5 Things You Should Know: This brochure provides information about depression in women including signs and symptoms, types of depression unique to women, treatment options, and how to find help.
  • Men and Depression: Men and women may experience depression very differently. This brochure describes common signs and symptoms, and treatment options for depression in men.
  • Older Adults and Depression: This brochure describes the signs, symptoms, and treatment options for depression in older adults.
  • Perinatal Depression: This brochure provides information about perinatal depression including how it differs from the “baby blues”, causes, signs and symptoms, treatment options, and how you or a loved one can get help.
  • Seasonal Affective Disorder: This fact sheet includes a description of seasonal affective disorder (SAD), signs and symptoms, how SAD is diagnosed, causes, and treatment options.
  • Seasonal Affective Disorder: More Than the Winter Blues: This infographic provides information about how to recognize the symptoms of SAD and what to do to get help.
  • Teen Depression: More Than Just Moodiness: This fact sheet is intended for teens and young adults and presents information about how to recognize the symptoms of depression and how to get help.
  • Shareable Resources on Depression: Help support depression awareness and education in your community. Use these digital resources, including graphics and messages, to spread the word about depression.

Federal Resources

Research and Statistics

  • Journal Articles: This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
  • Statistics: Major Depression: This webpage provides information on the statistics currently available on the prevalence and treatment of depression among people in the U.S.

Multimedia

  • NIMH Experts Discuss the Menopause Transition and Depression: Learn about the signs, symptoms, treatments, and latest research.
  • Mental Health Minute: Depression: Take a mental health minute to watch this video on depression.
  • NIMH Expert Discusses Seasonal Affective Disorder (SAD): Learn about the signs, symptoms, treatments, and latest research on SAD.
  • Discover NIMH: Personalized and Targeted Brain Stimulation Therapies: Brain stimulation therapies can be effective treatments for people with depression and other mental disorders. NIMH is supporting studies exploring how to make brain stimulation therapies more personalized while reducing side effects. This video describes transcranial magnetic stimulation and electroconvulsive therapy for treatment-resistant depression.
  • Discover NIMH: Drug Discovery and Development: One of the most exciting recent breakthroughs from research funded by the NIMH is the development of a fast-acting medication for treatment-resistant depression based on ketamine. This video shares the story of one of the patients participating in a NIMH clinical trial, and how ketamine infusions changed her life and gave her a sense of purpose. In addition, Dr. Carlos Zarate, a senior clinical investigator in NIMH’s Intramural Research Program, describes his groundbreaking research on ketamine.

Last Revised: July 2022

Unless otherwise specified, NIMH information and publications are in the public domain and available for use free of charge. Citation of the NIMH is appreciated. Please see our Citing NIMH Information and Publications page for more information.